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HomeMy WebLinkAboutBuilding Permit #66415 - 380 FOREST STREET 2/23/2015BUILDING PERMIT of t%ORT#1 qti TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION:`':' °yyy' t Permit XAMINATIONPermit No#: Date Received re D Date Issued: .22 ANXIr CHU s���y RIMPORTANT: Applicant must complete all items on1his page "a"ATI N PROPERTY€OWNER'-Y NE: �C Tin t N -t N 4b TT R 1.,QgiHi-- -ibJED'istric7--ETs 0. - YPS1 Machihe fto Village gdo VP'c /1n ) TYPE OF IMPROVEMENT PROPOSED USE c-olitf, tdrN� m Residential Non- Residential El New Building A One family D Addition 0 Two or more family 11 Industrial it Alteration No. of units: 0 Commercial [I Repair, replacement Ei'Assessory Bldg El Others: 11 Demolition El Other T6 UTjIqpA pn� rsk-4�rbt., q(� Utbt;KIF I 1UN Or WORK TO BE PERFORMED: 0,V e- 'ev C>" 6 ea -f i 7q -y Sew -1,4 1-5 6) t c A 6),a -x 12 q� S, V OWNER: Name: Address: J. Identification - Please Type or Print Clearly L -.L-,-711 (Vol 7-- Phone: Z,&1-2, c-olitf, tdrN� m Ad -re-4s�- Oz/ 7 Supervisor s Construction License e, IH qm—�Mjhov e -Exb—'(Date. -/-.v ARCHITECT/ENGINEER Phone Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F. Total Project Cost: $ , F� FEE: $ L) Check No.: 16 69Receipt' No.': NOTE: Persons contracting with unregisteredcontractors do not have ,cces he guaranty fund i a Location Date No. TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee $ TOTAL Check# ,* k, 28501 11 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE 4F SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming �o s Well ❑ Tobacco Sales ❑ FooNga�ekaX ale'A 0 Private (septic tank, etc. ❑F1v Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature_ CONSERVATION Reviewed on Sianature COMMENTS HEALTH } COMMENTS 41 Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Commen Comme IWater & Sewer Connection/Signature & Date Driveway Permit 4bPW Town Engineer: Signature: Located 384 Osgood Street IFIRE+D.EPARTMENiI =, Tem = 1®um _sterron site w esm9 _=x lnoi w . z_ 4Located�at,E12�4tMain�Str,.eet i "ire 4D -- r epartmen __ a � f�signature/date a CpOMMENT S; - - Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use) 3 ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 No Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application L3 Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract E3 Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 W 1 /_.t E 10 H Q W 2 U. 0 ac p m v u a� \6 O LL N N ' y., ❑. Ln W a Ln Z Ve z D = m O C 7 L.LL CLO 7 w v E U LL a en Z (J Z 00 J C UA 7 w LL 0 0. Ln Z Q p W J W 110 7 Q' u .L N L.L. oc O u 0 CA ? Ln Q CA 7 d' LL Z' ui C f - Q W c W 5 6L L m z N 41 N N p Y O N r L %P O LL !JJ F=- O Ca o_ � r C• L � �CL�4)+ d Q O ++ OF d w. - o d C C � L O L L �O 8 c NCD E " o `D o Z CL W �Mn O O : t 'y C =o� L Q $ a o=� Q L L LC Q. d m W_ _ -a— O O '02D % N O O-tO � O y.+ it U S. 0 O 'a , N (D > y= c N -0 O *Z S00 F. z G to z W w CL w H LLIN� I.f CL 0 m Z J_ m r U z U W z LS Z Jim Bampost N. Andover, Ma. CYS Finish Carpentry POB. 335 Hathorne, Ma. 01937 978-265-3001 Contract Remove Separation Wall -Remove wall between family room and bedroom -Box in support beam and crown -Box in Lally columns -Repair walls and ceiling as needed -Remove Electric in wall -Install 6" recessed old work cans and LED lights in old bed room -Remove Kitchen cabinets and tops -Reinstall uppers in garage -Rework refrigerator opening to move Frig. Back -Repair walls as needed -Install new door to furnace room and trim install make up air in furnace room -Clean an prep floors for new carpet and pad -install the floor in front of back door -Clean up and remove all trash ** Have approx. 84sq.yrds of Christopher Jones Jim Bampost 2/5/15 Materials $2,040.00 Labor $5,850.00 Allotm nt $2,370.00 OP ID: DF s CERTIFICATE OF LIABILITY INSURANCE CnVFRAC;FS CFRTIFICATF NI IMRFR• RFVIRI(1AI MI IMRGR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DATE 02/05/2015 ' 02105/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: 781-455-6664 Brown & Brown of MA, LLC DBA Fax: 781-4530204 Richard W. Endlar Ins. Agency - 858 Washington St. Ste #200 Dedham, MA 02026-6099 Daniel M Fiscus CONTACT NAME: PHONE FAX Alc No Ext): A/C NOY, E-MAIL ADDREss: PRODUCER CJFIN-1 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # 06/02/2015 INSURED CJ Finish Carpentry & INSURERA: Travelers Insurance Co. 19046 Renovation Christopher X. Jones d/b/a P.O. Box 335 INSURER B: INSURER c GENERAL AGGREGATE $ 2,000,00 Hathorne, MA 01937 INSURER D: $ INSURER E: INSURER F: - CnVFRAC;FS CFRTIFICATF NI IMRFR• RFVIRI(1AI MI IMRGR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SWVD UER POLICY NUMBER MFF MIDDLICYIYYYY PLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR - 6806374N7781442 06/0212014 06/02/2015 EACH OCCURRENCE $ 1,000,00 DAMAGET ES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PEO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS - SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS _ - _ - COMBINED SINGLE LIMIT . - $ - (Ea accident) BODILY INJURY (Per persori) $ BODILY INJURY (Per accident) $ _ PROPERTY DAMAGE $ (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB HCLAIMS-MADE OCCUR - - - - EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ . $ - WORKERS COMPENSATION AND EMPLOYERS' LIABILITY - Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE D? OFFICER/MEMBER EXCLUDE - ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A - WCSTATU- 0TH- TORY LIMITS ER E.L. EACH ACCIDENT $ - E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) _ MM=TA■ I JINM■ J_ IS1 MUM ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Department - - 1600 Osgood Street, Suite 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE � ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD rm.e commonwealth of.Massachuyetts , r - Department o, I dust�ifcrAeeld&ts _ Offlee of Investigations 600 Washington Street Boston, MA 02111 -www.massgov/dia orke& Com ensati.onInsurance Affidavit: BuRders/Contractors/Flecfz�cxaan�lPXwmbe�� Please Print X,egxbl. e -S #: F 7 F 6 6-1 061 Are you an employer? Check the appropriate box: 4. ❑ I am a general contractor and I 1. [I I am a employer with ._______ employees Gulland/or paw Vie). have, ned the, sub -contractors T 2, I am a solo proprietor orpariner- listed on the attached sheet. These sub -contractors have ship an&kave, no employees working for me in any capacity. workers' comp. insurance. 5, ❑ We area corporation and its tNo workers' comp. bmFauce officers have exercised their required.] 3. [] X am a homeowner doing all work right of exemption per MGL c. 152, §1(4), and we have no myself. [No workers comp.- employees. o workers' insurance required.] ? comp. insurance required] Type ofproject (required): 6. [l New cOnstraction f 7. Remodeling 8. [[ Demolition -1 9. [] Building addition 10.[] Blectdcal repairs or additions 11.[] Plumbing.repairs or additions 12.[I Roofrepaks 13.[] Other xAny appIicantthat checks box#1 mustabo fdl outthe sectionbel6w shoY&gtheir workers' compensationpolicyiutormatron. x Homeowners who submit this affidavit indicatingthey are doing aliwork and then hire outside contractors must submit anew affidavit indicating such. xContractars that eheckthis box mast attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. I ayn are employer that is proviciir�g workePs' compe��safion insurance fog ryty etnproyees: Berow is file po[icy anrijob site information. Insurance Company Policy 0 or S elf -ins - Lic. Expiration Date; lob Site Address: CitylState/Zip: Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date). Failure to secure coverage as xequixecLunder Section 25A of MGL 0,152 can lead to the imposition of eximinal penalties of a fine up to $1,500.00 andlor one-year imprisonment, as well as civil: penalties in the form of a STOP WORD ORDER. and a fine of up to $250.00 a day against tha violator. Be advised that a copy of this statement maybe forwarded to the Office- of fnvestigaiions of the DjAfirVurance, coverage verification. X do Xiereiiy cer ' de s pen es afpexjury Mat file ir�formatiorx provided alcove is true and correct. /� - -- � G,�� .--� „atP• ���a. /rte" Of,,-, a, use only. Do not write in tliis area, to he completed by city or toWR offlciczl. City or Town: 1?ermit/License # Issuing Authority (circle one): 1. Board of Ffealth 2. Building Department 3. City/Tows Clark4. Electrical inspector 5. Plumbing Inspector 6. Other J Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defrned as "...every person in the service of another under any contract of hire, - express or implied, oral or. written." An employe. is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise; and including the legalrepresentatives of a•deceased employer, or the receiver or trusteetof an individual, partnership, association or other legal entity, employing employees. Llowever the owner of a dwelling house having not more than three apartments and who resides, therein, or the occupant of the dwelling house of another who employs borsons to do maintenance, consinzetion or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not b ecause of such employment be deemed to be an employer." _ , .y, MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit`ia o ieraie`k busvie- oz•'to construct huffdi�ngs in the com>ztoxtwealth for any applicant who has not produced•a.cceptable evidence of compliance with the insurance coverage ie4uveed:' Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certiticate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are notregaired to carry workers' compensation. insurance. If m LL C or LLP does have employees, apolicyis required. Be advised that this afixdavitmay be submitted to the Department of IudusWal Accidents for confirmation of insurance coverage. also be sure to sign and date the affidavit. The affidavit should be, returnedto the city or town that the application for theperntit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should 'enter their self-insurance license number on the appropriate lice. ` City or Town Officials Please be luxe that the afCxdavitis complete andprinted legibly. The Deparimenthas provided a space atthe bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/Rcense number whiehwill be used as a reference number. fn addition, m applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current PORGY information (ifnecessary) and under "fob Site Address" the applicant shouldwrite "all locations in {city or town)." .A. copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit id on file for fixture permits or licenses. Anew affidavit must be filled out each Year. Where ahomeowner or citizen is obtaining a license o>: bermitnotrelatedto any business or commercial venture (i.e. a dog license orpermit to burn leaves etc) said person is NOTrequired to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do nothesitate to give us a call. The Department's address, telephone aiid fax number: Th.6 Coliawnw. ealth ofM�ssarhv.<SPtf� Departmont OffhdmWal Aaoldontg CQa washi gtca ge=t Boston, M. 02111 617-7-27-49 00 at 406 or X-877, MASSAF`.F Revised 5-26-05 Fax # 617-727-7749 Wv..Mass,g0VM4 � � � _-mow_ ..:.�„�._ ._ �- �, �' � ,. _ �'� i k � ' Massachusetts - Department of Public Safety Board of.Buiidin.g Regulations and Standards Construcdon Supe6'i'mr License: CS -056310 4 j11 CIMSTOPHER N 70 PO BOX 335/505 2'iAT HATHORNE l 0193 \ rl 1 _ �I i .l'is S WA �. Expiration Commissioner 10/2512014